The latest research finds: more than 1/4 of the elderly in rural areas are at high risk of dementia?

*For medical professionals, there are currently about 10 million Alzheimer's disease (AD) patients in China, and it is expected that by 2050, there will be more than 40 million
.

Only by fully understanding AD, early identification, early diagnosis, and early intervention, instead of treating it as an inevitable symptom of aging, early diagnosis and early wisdom, can press the pause button for AD progress
.

Mild cognitive impairment (MCI) is mainly manifested by memory impairment, and other cognitive functions may decline to some extent, but it does not meet the diagnostic criteria for dementia.
Relevant studies [1] found that 15%-20% of MCI annually Patients develop AD, which is a high risk state of dementia.
Therefore, MCI is of great significance for the prevention and treatment of AD and other dementias
.

 On March 9, 2022, a study [2] published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association (IF: 21.
567) showed that the prevalence of MCI in the elderly in rural China exceeded one-quarter, which is MCI.
, AD and other dementias provide important information for early diagnosis and early treatment
.

 So, how did the research work? What's new? Faced with this situation, what can we do? "Medical Neurology Channel" specially invited Professor Du Yifeng, the corresponding author of Shandong First Medical University Affiliated Provincial Hospital (Shandong Provincial Hospital), to interpret for everyone
.

 Research summary (swipe up and down to view full content)▌Background: In China, epidemiological studies on MCI and its subtypes have rarely focused on rural residents
.

 ▌Methods: This population-based study included 5068 participants (age ≥60 years) living in rural communities
.

We defined MCI, amnestic MCI (aMCI), and non-amnestic MCI (naMCI) according to Peterson criteria and combined neuropsychological assessment with clinical assessment
.

 ▌Results: The overall prevalence of MCI, aMCI and naMCI were 26.
48%, 22.
30% and 4.
18%, respectively
.

The prevalence of MCI increases with age
.

The adjusted odds ratio (OR) for MCI was 0.
71 (95% CI, 0.
61-0.
82) for primary school (compared to illiterate), 0.
30 (0.
24-0.
39) for middle school or above, 1.
35 (1.
09-1.
67) for farmers, and 1.
09 for alcohol consumption 0.
65 (0.
54-0.
78), 1.
43 (1.
20-1.
70) for history of stroke, and 1.
14 (0.
95-1.
36) for any apolipoprotein E (APOE) ε4 allele (vs ε3/ε3)
.

 ▌Conclusion: MCI affects more than one-quarter of the rural elderly in China.
At the same time, this study suggests that advanced age, low education level and non-mental work may increase the risk of MCI, while the history of hypertension and stroke may increase the possibility of naMCI
.

This study also found that APOE genotype was not associated with MCI and MCI subtypes
.

 01 Could you please introduce the background of this research? We know that AD is a latent progressive brain degenerative disease with a long course of disease.
Patients are usually diagnosed after the age of 60.
Compared with other diseases of the elderly, AD not only has a high incidence, but also can lead to severe disability
.

At present, there are about 46.
8 million AD patients in the world, and there are about 10 million AD patients in China
.

AD patients have memory impairment as the main clinical manifestation.
As the disease progresses, the ability to deal with problems such as learning/work declines, and language skills such as understanding and expression are impaired, and eventually they will lose their ability to take care of themselves in daily life
.

At present, AD has become the fifth leading cause of death among Chinese residents, bringing a heavy burden to society, families and individuals
.

 Then, MCI, as a transitional state in the progression from normal aging to AD, is a very important juncture that needs our attention and research
.

In 2020, an article published by the team of Professor Jia Jianping from Xuanwu Hospital of Capital Medical University in The Lancet [3] showed that there are more than 30 million MCI patients, which shows that the number of patients with MCI is huge
.

 In view of this, our team began to establish a standardized community cohort of elderly people in 2013 - "Shandong Yanggu Aging and Dementia Cohort Study".
The team of Professor Qiu Chengxuan of the School of Medicine cooperated to carry out the China Dementia Multimodal Intervention Project (MIND-CHINA), which is a randomized controlled, multi-level, individualized, multi-dimensional large-scale community population intervention study targeting the main controllable risk factors of dementia.
Aims to reduce the risk of dementia, AD and disability through multimodal interventions
.

02What guidance does the results of this study have on the clinical practice of AD and other dementias in my country? The results of this study will help us to further understand and understand MCI to a certain extent.
For clinicians, it may have a certain guiding role in the early identification and early intervention of MCI in the future
.

03 Do you have any management suggestions for the current situation that MCI affects more than a quarter of the rural elderly in China? The ultimate goal of our research on the etiology, risk factors, and multimodal intervention methods of the disease is to reduce the prevalence of MCI and various types of dementia in elderly patients and reduce the transformation of MCI to dementia.
How to manage and improve senile cognitive impairment is a We have been thinking about the problem, for now, the following four aspects make our team mainly consider the problem
.

▌First, strengthen rural residents' awareness of dementia and raise awareness of disease prevention
.

 Correct the concept and realize that "old confusion" is not a normal performance and needs to be diagnosed and treated
.

Go deep into rural areas and communities, and use various forms of publicity means, such as radio, television, newspapers, new media, community science publicity, etc.
, to make rural residents aware of the dangers of AD and other dementias, that is, AD is a disease that may affect patients and dementia.
Family and even society bring heavier influence and burden
.

At present, the publicity of various new media is a good entry point.
It is hoped that through publicity and education, the awareness of early prevention, early medical treatment and early treatment of rural residents can be improved
.

 ▌Second, pay attention to high-risk groups, especially rural high-risk groups
.

 There are many risk factors for MCI or AD and other dementias, including age, brain injury (brain trauma, cerebral infarction, etc.
), low education level, unhealthy life>
etc.

 The elderly in rural areas are relatively less vigilant about these risk factors.
Some people may say, "Oh, it doesn't matter if I don't hear, I'm old," but they don't realize that treatment is actually needed and can be treated
.

In particular, we should pay attention to the "old age loneliness" of the elderly in rural areas.
Young people in rural areas generally go out to study/work.
The elderly are easily disconnected from society and have psychological problems, which are important risk factors for MCI, AD and other dementias
.

 All in all, due to various limitations such as educational level and economic conditions, the elderly in rural areas may not pay much attention to these risk factors.
We need to find a way to make them pay attention, or we should pay attention to these groups
.

 ▌Third, strengthen early identification, early diagnosis and targeted intervention
.

 With the increasing problem of population aging in our country, the prevention and treatment of AD and other dementias is of paramount importance
.

How to do early identification, diagnosis and intervention requires us to further think and practice, and put concrete measures in place
.

 For example, in terms of intervention, attention should be paid to the management of controllable risk factors, promoting a good life>
.

 In short, the cooperation of government, medical and health institutions, and media can better promote the construction of AD and other dementia prevention and treatment systems in rural areas, including publicity, prevention, diagnosis, treatment, and care
.

 ▌Fourth, strengthen the professional training of various grass-roots medical and health institutions, and actively carry out AD prevention and treatment
.

 In recent years, more and more attention has been paid to the identification, screening and intervention measures of MCI stage, but there are some situations such as incomplete understanding and unskilled skills of primary doctors on AD and other dementias
.

It is necessary to strengthen the sinking of medical resources, and provide guidance and training to medical staff such as grass-roots disease control centers, community health service centers, and township health centers, so as to improve the prevention and treatment capabilities of grass-roots medical institutions, thereby increasing the access of ordinary people to medical resources such as AD prevention and treatment.
sex
.

  04What do you think is the novelty and limitation of this research? Our study used a combination of neuropsychological assessments and clinical assessments for diagnosis, and further studies were conducted on the prevalence and associated risks of MCI and its subtypes
.

In addition, this study may be one of the largest single-center studies on MCI in rural communities in China.
It provides reliable data for the epidemiological characteristics of rural community populations in China, and has certain reference significance for the next step of prevention and treatment
.

 The limitation may be that this study is still a cross-sectional study, and the time is not long enough.
The research in this area needs to be strengthened for further exploration and observation
.

Reference: [1] https://mp.
weixin.
qq.
com/s/nP8a7NeC2iKKZPhfnYKKwQ[2] Cong L, Ren Y, Wang Y, et al.
Mild cognitive impairment among rural‐dwelling older adults in China: A community ‐based study[J].
Alzheimer's & Dementia, 2022.
https://alz-journals.
onlinelibrary.
wiley.
com/doi/full/10.
1002/alz.
12629[3]Jia L, Quan M, Fu Y, et al .
Dementia in China: epidemiology, clinical management, and research advances.
Lancet Neurol.
2020;19(1):81-92.
Expert Profile Prof.
Yifeng Du Head of Department of Neurology, Shandong First Medical University Head of Department of Neurology, Shandong Provincial Hospital Shandong Province Director of Clinical Research Center for Neurological Diseases Taishan Scholar Distinguished Expert Vice President of Neurology Branch of Chinese Medical Doctor Association Vice President of Dementia and Cognitive Impairment Group of Neurology Branch of Chinese Medical Association Undertook a number of scientific research projects such as the National Key R&D Program of the Ministry of Science and Technology, the National Natural Science Foundation of China International Cooperation Key Project, and the National Natural Science Foundation of China General Project.
Dementia, JAMA Neurology and other journals have published more than 200 academic papers.
First publication: Neurology Channel of the Medical Community Accuracy and reliability at the time of review and approval, but does not make any commitments and guarantees for the timeliness of the published content, and the accuracy and completeness of the cited materials (if any), and does not assume any responsibility for the outdated, any liability arising from possible inaccuracies or incompleteness of references
.

Relevant parties are requested to check separately when adopting or using it as a basis for decision-making
.

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